The article attributes the remarkable decrease in premiums to the Affordable Care Act. An estimated 75% of those who buy individual insurance will be eligible for income-based subsidies, further lowering the price of health insurance.

Wait. Seriously? Those prices are way less than what I pay for my employer-subsidized plan.posted by schmod at 1:00 PM on July 17, 2013

OF COURSE the premiums have dropped. Next year the penalty for being uninsured goes into effect.

So, let's say the penalty for being 25, healthy, relatively poor, and uninsured is $500. Ok dokey. Now let's say you're a savvy health insurer. You can offer a cut rate plan with a $200,000 deductible and $300,000 premium that covers almost fucking nothing at all for $450, which the uninsured guy has to take because he needs that $50. "Yay!" says Mr Health Executive "I get free money!" Meanwhile the young poor 25 year old gets fucked out of $450.

It isn't a good thing. Of course none of the plans offerend on the exchange will be like that at all, so it's a completely moot point.posted by MCMikeNamara at 1:06 PM on July 17, 2013 [35 favorites]

From the article "The plans to be offered on the exchanges all meet certain basic requirements, as laid out in the law, but are in four categories from most generous to least: platinum, gold, silver and bronze. "

So that bogeyman of an insurer that will scam the healthy by offering a bad plan for just a hair under the tax is not going to happen.posted by oddman at 1:11 PM on July 17, 2013 [8 favorites]

Ok dokey. Now let's say you're a savvy health insurer. You can offer a cut rate plan with a $200,000 deductible and $300,000 premium that covers almost fucking nothing at all for $450... How is this a good thing exactly?

Because that's not what's happening. The levels of coverage have mandated requirements for coinsurance, copays, and deductibles.posted by the jam at 1:12 PM on July 17, 2013 [28 favorites]

You can offer a cut rate plan with a $200,000 deductible and $300,000 premium that covers almost fucking nothing at all for $450.

I don't know what those gold and platinum plans would typically offer, but they are substantially less expensive than typical HMO plans currently available in Manhattan, and none of them are under $500. If they really are shitty plans, the penalty is cheaper.

Anyone have links to what gold and platinum plans are supposed to offer?posted by maudlin at 1:12 PM on July 17, 2013 [2 favorites]

So, let's say the penalty for being 25, healthy, relatively poor, and uninsured is $500. Ok dokey. Now let's say you're a savvy health insurer. You can offer a cut rate plan with a $200,000 deductible and $300,000 premium that covers almost fucking nothing at all for $450. "Yay!" says Mr Health Executive "I get free money!" Meanwhile the young poor 25 year old gets fucked out of $450.

How is this a good thing exactly?

There's regulatory language in Obamacare that requires minimum levels of care and tiered plans. It's even mentioned in the article.posted by zombieflanders at 1:12 PM on July 17, 2013 [7 favorites]

So...just to back up my vitriol with numbers.

The tax penalty when fully phased in will be $695 a year. The lowest cost plan offered in the article is $55/month or $660 a year. They're probably doing the plan now at the low cost price to get the statistics in line to make sure they can make that $660 profitably (paying their overhead and whatever pitiful excuse for medical care they offer). Plus the difference in what the poor can save has to be enough for them to be incentivized to swallow their disgust and cut a check to a healthcare mogul. Of course, The least expensive plans, some offered by newcomers to the market, may not offer wide access to hospitals and doctors, experts said..

So yeah. It's even worse than my above hypothetical. The poor gets fucked out of $660 a year and he only saves $35. We could call that the "dead weight loss of his pride". Beautiful.posted by ishrinkmajeans at 1:14 PM on July 17, 2013 [1 favorite]

Oh btw, I have no faith that the language of law mandating standards of coverage can't be subverted by the medical industry to act in the absolute worst bad faith possible. If you don't believe that's going to happen I don't think you've been paying attention.posted by ishrinkmajeans at 1:16 PM on July 17, 2013 [1 favorite]

wow, someone got up on the wrong side of the Obamacare bed this morning.....posted by HuronBob at 1:17 PM on July 17, 2013 [12 favorites]

I was amazed at this bit:

Because the cost of individual coverage has soared, only 17,000 New Yorkers currently buy insurance on their own. About 2.6 million are uninsured in New York State.posted by smackfu at 1:17 PM on July 17, 2013 [4 favorites]

ishrinkmajeans: please read any of the most basic guides to the ACA available in sundry places around the internet. What you are describing simply makes no sense at all within the framework of the law.posted by yoink at 1:17 PM on July 17, 2013 [17 favorites]

Oregon has a calculator available that shows my individual plan doubling. I'm not sure who to believe at this point.posted by elwoodwiles at 1:18 PM on July 17, 2013

From the article:only 17,000 New Yorkers currently buy insurance on their own. About 2.6 million are uninsured in New York State.

Sweet Jebus.

Also, when reporting that the cost of a "health plan" is dropping by 50%, understand that those words between the quotes are about as complex and malleable as any two words can be, even with Affordable Care Act mandates.

We've gotta get far more radical to fix our Health Care crisis. My big hope for Affordable Care Act is that people realize that reform of this industry is both completely necessary and not "socialism", and for this to prime the pump for real reform down the line. I'm not optimistic.posted by mcstayinskool at 1:19 PM on July 17, 2013 [2 favorites]

Oregon has a calculator available that shows my individual plan doubling. I'm not sure who to believe at this point.

Different states will have very different results--partly depending on the robustness of the competition within any particular state, partly depending on the way the state has gone about setting up the exchanges etc. Generally speaking, people in larger states with more competitors entering the market will probably do better than those in smaller states.posted by yoink at 1:20 PM on July 17, 2013

yoink, I've pointed out how the numbers work and my belief that the health insurance industry will subvert the law to get around minimum coverage requirements. Your stating "go read the law" contributes nothing and I award you no points. If you disagree, post a fact or argument of your own.posted by ishrinkmajeans at 1:20 PM on July 17, 2013 [1 favorite]

You're stating "go read the law" contributes nothing and I award you no points.

You need to read the law. You are wrong, as you usually are when you drop this kind of fighty comment in the beginning of the thread. It is not Metafilter's job to educate you when you engage in this kind of behavior. The burden is on you to have something to contribute to an interesting discussion about the content of the post.posted by Aizkolari at 1:22 PM on July 17, 2013 [76 favorites]

I don't really know how anyone can engage with "I think the industry will somehow find a way to make this worse for people."posted by smackfu at 1:22 PM on July 17, 2013 [2 favorites]

also, ishrinkmajeans, people below certain income levels are exempt from the fine for being uninsured. I agree with you that insurance companies will put themselves into whatever contortions are possible in order to avoid having to actually cover people, but I have read the law (and discussed it with people who are more knowledgeable than I am about such things) and I have confidence that your six-figure deductibles are impossible. If you want specific cites in order to gain some assurance of your own, let me know.posted by KathrynT at 1:23 PM on July 17, 2013 [3 favorites]

I've pointed out how the numbers work and my belief that the health insurance industry will subvert the law to get around minimum coverage requirements.

Your belief is lunatic raving. It's noise and a distraction. You have nothing of substance to offer.posted by Slap*Happy at 1:23 PM on July 17, 2013 [17 favorites]

Your "belief that the health insurance industry will subvert the law to get around minimum coverage requirements" is not actually a "fact," you realize.

Not to defend insurance companies, but they're pretty heavily regulated, and unless you can prove that the Bronze option is going to be less good for people than nothing at all, you're not actually conducting an argument.posted by Etrigan at 1:23 PM on July 17, 2013 [4 favorites]

If you disagree, post a fact or argument of your own.

ishrinkmajeans, you are so far from making even the most basic sense on the topic that it is simply not worth arguing with you (and I assure you this is my final response to you). It is as if you are arguing that cars in the US are primarily wind-powered or that basketball is a sport played by teams of 30 who compete to stuff baloney into the blowholes of whales. Go find out how the system actually works (including who gets subsidized and how much and what the limits on profits for the health insurance companies are etc. etc. etc.) and then you may be able to make a sensible contribution to the discussion.posted by yoink at 1:24 PM on July 17, 2013 [23 favorites]

Lots of arguing is going to happen now.. I just need to know do I put the smirky smiley, or the big grin smiley after

I am so excited and terrified for October. Our Healthy NY plan is being discontinued two months before I give birth and there's a chance that it might be substantially cheaper for us (we currently pay $700 a month, a significant portion of our income, for two people) but we really don't know and it's scary guys, scary!posted by PhoBWanKenobi at 1:25 PM on July 17, 2013 [2 favorites]

I've had nothing but hassle with health insurance this year - they seem to be getting in every last ounce of shitty they can right now. In the absence of the whole thing being ditches fir something sane here's hoping a crappy system continues to get marginally less crappy.posted by Artw at 1:26 PM on July 17, 2013

I've pointed out how the numbers work and my belief that the health insurance industry will subvert the law to get around minimum coverage requirements.

The industry hasn't been able to skirt around the requirements that have already gone into effect, such as the requirement to let children stay on their parents' health insurance until 26, or for insurers to cut checks to consumers if they spend less than 80 percent of premiums on healthcare. You'd think they'd want to skirt around those.posted by ultraviolet catastrophe at 1:27 PM on July 17, 2013 [4 favorites]

I have no faith that the language ... can't be subverted by the medical industry to act in the absolute worst bad faith possible.

I mean, I have private insurance and the companies... they do this to me already. I'm not standing for or against anything at this point, because I'm pretty far out of the obamacare loop honestly, but if you haven't experienced this from normal, everyday, look-at-how-lucky-I-am-to-have-it insurance then you are the exception. They try to fuck you if they can.

Do you really think that they're bastions of honesty as things stand now? That's part of the reason people aren't happy with private insurance as it stand now.... just getting my wife's contacts paid for is a pain.... When I got bitten by a poisonous snake it was a huge fucking mess getting Blue Cross to pay up....

Not making this all about me, because this isn't something I've ever brought up without other people having similar stories and complaints... our system sucks, it's the most expensive (or one of) in the world, and the results that we get are decent but not at all as impressive of many other countries that provide health care as a basic right/service. I'm not citing those 'claims', as I suspect you may be ready to label them, because 1) if you're working off the claim of some sort of precognition of how things are going to pan out and inherent distrust of number, statistics, facts, figures, and laws then nothing is going to really phase you and 2) they're pretty well accepted so feel free to whine about numbers... while just typing in your own, calling them gospel and discarding commentary to the contrary I might add.posted by RolandOfEld at 1:28 PM on July 17, 2013

Meanwhile the employer mandate/reporting has been put off for at least a year, so is this some odd coincidence? Will companies just drop their "cadillac" plans and say Now lookie there see how cheap it is to buy your own plan? Will people be suckered in to buying from the exchange?posted by Gungho at 1:32 PM on July 17, 2013

If anything, I see this compulsory health insurance market walking hand in hand with the compulsory auto insurance market.

It'll start relatively cheap, but with all the dollars spent in competing Cavemen-lizards and ladies with 50s hairdos clamoring for attention through 30-second humor bits on TV, combined with sketchy price-basing statistics and risk segments, it'll inch slowly but surely upwards to squeeze every last cent out of EVERYONE. At least you can opt out of car ownership to avoid the car insurance payments. Opting out of life might put a damper on your day.

Car Insurance for an average adult in 1980 (in FL) was $266.65 per year (adjusted for inflation = $753). That's a rate of $62 per month in 2013 dollars. It could be said that there are more cars (but they're safer), more people to steal them (but they're harder to steal), and so even given that, let's plug in another $40 a month to adjust for that.

What's to prevent an insurance company from offering a plan that, for most people, is only slightly less than the penalty for not paying for insurance, and offers almost no healthcare coverage whatsoever? Everyone who is saying that I'm wrong is silent on this issue. This is the market rational thing to do, and I know of no provision in the law to prevent this from happening. And hey, the numbers I threw out there seem to support my hypothesis. I understand that people under a certain amount of income can get help to pay for insurance. Fine. But that doesn't mean that people a) know of the subsidies and sign up for them or b) that people just over the subsidy or not covered for whatever reason won't face this dilemma.

I mean, I don't need to know the absolute intricacies of the ACA to know that this can, and seems to be on cursory examination, to be a huge problem. I don't need to know the chemical composition of cow manure to know I don't want to eat a shit sandwich.posted by ishrinkmajeans at 1:34 PM on July 17, 2013

I've got it good right now, health insurance-wise, and have had good coverage for several years, but I will never forget what it felt like to need a doctor and be unable to go to one when I was 19 and working at minimum wage. It felt like such a betrayal. Sure, I'm a bit apprehensive about what might happen as this all shakes out, but that the current system does what it does to so many people is just full-stop unacceptable. If some good stuff gets broken and the new arrangements need tweaking, that's a price I'm wiling to pay.posted by jon1270 at 1:34 PM on July 17, 2013 [6 favorites]

ishrinkmajeans: "Your stating "go read the law" contributes nothing and I award you no points. If you disagree, post a fact or argument of your own."

What's to prevent an insurance company from offering a plan that, for most people, is only slightly less than the penalty for not paying for insurance, and offers almost no healthcare coverage whatsoever?

The same thing that keeps people from taking out car insurance on their dog from a brewery, giving the dog a bath and a treat, and then collecting the inheritance from the motorcycle industry representative.posted by RolandOfEld at 1:37 PM on July 17, 2013 [32 favorites]

What's to prevent an insurance company from offering a plan that, for most people, is only slightly less than the penalty for not paying for insurance, and offers almost no healthcare coverage whatsoever?

The mandated levels of coverage. A Bronze plan must cover 60% of health insurance costs for the average subscriber, a Silver plan 70%, a Gold plan 80%, and a Platinum plan 90%. That is the law.posted by KathrynT at 1:37 PM on July 17, 2013 [22 favorites]

I would kill for $102/month car insurance.

My insurance is waaaaaaay cheaper than that. Admittedly, my car is 13 years old and I don't have full coverage, but that's why a statistic like that is pretty meaningless. What's the cost for car insurance of an average adult in FL now?

What's to prevent an insurance company from offering a plan that, for most people, is only slightly less than the penalty for not paying for insurance, and offers almost no healthcare coverage whatsoever?

The law. This is like asking what's to prevent me from walking into my neighbor's house and stealing her big-screen TV.posted by kmz at 1:37 PM on July 17, 2013

What are you contributing here, exactly?

I'd like there to be a critical discussion about whether this is a 'good' thing or not. I suspect it's not. But I think that without people considering my position in this thread it would quickly turn into a self congratulatory circle of people saying how great Obama is. I'm trying to fight against what I percieve as the 'progressive concensus' that would say this is good without thinking about it. I WANT someone to tell me why I'm wrong. I want to think and learn critically about this topic.posted by ishrinkmajeans at 1:38 PM on July 17, 2013

I WANT someone to tell me why I'm wrong

People have told you why you are wrong. You have not listened, nor will you ever, given past experiences. You are not making a productive contribution to the thread.posted by 0xFCAF at 1:40 PM on July 17, 2013 [20 favorites]

What's to prevent an insurance company from offering a plan that, for most people, is only slightly less than the penalty for not paying for insurance, and offers almost no healthcare coverage whatsoever?

The law. There are minimum standards of coverage in there. You should probably read up on it.posted by Aizkolari at 1:40 PM on July 17, 2013 [3 favorites]

The least expensive plans, some offered by newcomers to the market, may not offer wide access to hospitals and doctors, experts said..

I WANT someone to tell me why I'm wrong. I want to think and learn critically about this topic.

You need to find a way to do that that doesn't involve doing this same old "I'll argue a hypothetical loud and strong and it's everybody else's job to convince me I'm not right" dance, then. We've talked to you about this, it's a problem, and you need to basically just walk away from this thread now because you've thoroughly poisoned the well on a "let's have a productive critical discussion thing" with your initial engagement.posted by cortex at 1:41 PM on July 17, 2013 [63 favorites]

What's to prevent an insurance company from offering a plan that, for most people, is only slightly less than the penalty for not paying for insurance, and offers almost no healthcare coverage whatsoever? Everyone who is saying that I'm wrong is silent on this issue. This is the market rational thing to do, and I know of no provision in the law to prevent this from happening.

Uh, the minimum levels of care and tiered plans mentioned several times. You obviously have internet access and the ability to type, why do they need to be written out for you?posted by zombieflanders at 1:41 PM on July 17, 2013

What's to prevent an insurance company from offering a plan that, for most people, is only slightly less than the penalty for not paying for insurance, and offers almost no healthcare coverage whatsoever?

At least you can opt out of car ownership to avoid the car insurance payments.

Not everywhere! Apparently in NC, they'd have taken my license if I stopped paying liability insurance, and I've never owned a car.posted by showbiz_liz at 1:43 PM on July 17, 2013

What's to prevent an insurance company from offering a plan that, for most people, is only slightly less than the penalty for not paying for insurance, and offers almost no healthcare coverage whatsoever? Everyone who is saying that I'm wrong is silent on this issue. This is the market rational thing to do, and I know of no provision in the law to prevent this from happening.

ishrinkmajeans, there are several line items in the law itself that aim to address this, but probably the most direct is this:

‘‘(3) CONTENTS.—The standards shall ensure that the summary of benefits and coverage includes—
...
‘‘(G) a statement of whether the plan or coverage—
‘‘(i) provides minimum essential coverage (as
defined under section 5000A(f) of the Internal Revenue
Code 1986); and
‘‘(ii) ensures that the plan or coverage share of
the total allowed costs of benefits provided under the
plan or coverage is not less than 60 percent of such
costs; ..."

By this process, the market has to evaluate its own products prima facie and more or less put that evaluation on the label. If it fails to meet basic criteria, it's ineligible for marketing (this is the same way we regulate drugs and biologics, by the way, by setting standard requirements for licensure and marketing).

Now I know you want someone to lie and say that industry isn't going to be testing the boundaries of what they can get away with, but this is a healthcare law that has--for its flaws--set the market as less important than the service that market is tasked with providing. As with everyone else saying the same thing, you can find these provisions on your own by reading the text of the act. There are many redundancies that have been instilled to very hopefully safeguard against loopholes, but some will invariably be found. I doubt there's room for the kind of grave exploitation of the poorest people based on provisions like the above.posted by late afternoon dreaming hotel at 1:44 PM on July 17, 2013 [1 favorite]

My insurance is waaaaaaay cheaper than that. Admittedly, my car is 13 years old and I don't have full coverage, but that's why a statistic like that is pretty meaningless. What's the cost for car insurance of an average adult in FL now?

I don't know what the average is, but I pay upwards of $180 (bad credit, no tickets/accidents), and my wife (no tickets/accidents) pays around $160.

But on health insurance, I have a $5,000 ER deductible on my cheapo work plan. ($75 month employee contribution). Wasn't a big deal until I had to go to the hospital recently. I'm paying $800 for a ER physician to give me a 150MG Naproxen and basically tell me to stop being a baby. But it's considered a Tier III medical visit because medicine was distributed.posted by Debaser626 at 1:45 PM on July 17, 2013 [2 favorites]

Some of the state’s best-known insurers, UnitedHealth Group and WellPoint, are also expected to participate.

I'd have more cautious optimism if the stock prices of these two companies weren't near their 5-year highs.posted by RobotVoodooPower at 1:47 PM on July 17, 2013 [1 favorite]

The ACA mandates (bronze level) an actuarial coverage of 60% and a year out of pocket max of 6400 or so, with a max deductible of $4000 ($2000). Which is not great, but it is coverage. I'm not sure whether there are more particular details on line-items other than those that must be covered (at 60/40 I presume). Are there requirements that specify 100% depending on line item? The bill is kind of a slog to work through and a search didn't find anything...

Also, I actually don't know how much wiggle room the "actuarial" coverage gives the insurance companies here…posted by smidgen at 1:52 PM on July 17, 2013

What you are describing simply makes no sense at all within the framework of the law.

This is an industry which is fundamentally in the business of finding ways to avoid paying for health care. If you think they're just going to roll over and take it because someone passed a law, you have a lot more faith in human nature and the goodness of giant megacorporations than I do.

Somebody has to keep watch, somebody has to enforce violations, and the enforcements have to have teeth. An easy glance over at Wall Street shows that this is not a state of affairs you can take for granted.posted by Mars Saxman at 2:00 PM on July 17, 2013 [4 favorites]

If you think they're just going to roll over and take it because someone passed a law

So, what do you think is going to happen? That people are going to be denied for preexisting conditions even when it is illegal? Has this happened in Massachusetts?posted by MisantropicPainforest at 2:05 PM on July 17, 2013 [2 favorites]

[Not sure how much clearer "walk away from the thread" could be.]posted by cortex at 2:12 PM on July 17, 2013 [7 favorites]

So, what do you think is going to happen? That people are going to be denied for preexisting conditions even when it is illegal?

The Act could be modified to reduce coverage levels, increase copays, etc. while maintaining or increasing costs to a captive market. I don't think there is reasonable expectation that the parameters of the healthcare law as written will remain static in the face of rising costs. The insured are a captive market, and I suspect that Wall Street and insurance companies know this because their stocks are at all-time highs.posted by Blazecock Pileon at 2:14 PM on July 17, 2013 [1 favorite]

This is an industry which is fundamentally in the business of finding ways to avoid paying for health care.

There is limited incentive for participants in the exchange to "find ways to avoid paying for healthcare" because there are hard caps on profit as a percentage of actual healthcare dollars spent. Beyond those caps the money has to be returned to the insured. We already know that the insurance companies have not found a way to wiggle out of this part of the law because it has already been successfully enforced.

And, sure, insurance companies have often behaved incredibly badly in the past, but there is something bizarrely out of whack in most people's conception that the health insurance companies are THE great thing wrong with America's health system. For one thing, have you ever heard this exchange: "I just got a new job, and it includes full medical benefits." "Oh, you poor thing, isn't there any way around that?" No, you haven't. And for why? Because, in fact, by and large having health insurance is a Good Thing in the US. Because by and large health insurance does, in fact, pay out for what it is required to pay out for. My wife and I have insurance through my job, and we both have presented a steady stream of weird and crazy expensive medical problems to our insurers over the years and those insurers have, time and again, stumped up very large sums of money to pay for treatment. Now, this is, no doubt, because we're employed by a very large employer and the insurance companies want to keep doing business with our employer--an advantage that people contracting singly with an insurance company don't have; for them, when they get sick they are nothing but a liability to the insurance company, so the company has a great incentive to find a way to get them off the books. But that is the beauty of the exchange systems. All those people who used to be simply be in a single one-to-one relationship with their ensurers now become part of a large and powerful bloc that is represented by state and federal agents. In order to participate in the exchanges the insurance companies have to foreswear the very means by which they used to bump people off their rolls when they presented with expensive illnesses: preexisting condition disqualifications, for example. If they try to pull that shit they won't just be dealing with poor Joe Blow and whatever legal aid he can rustle up, they'll be dealing with state and federal regulators who will have the power to terminate their right to participate in the exchange at all.posted by yoink at 2:19 PM on July 17, 2013 [18 favorites]

Car Insurance for an average adult in 1980 (in FL) was $266.65 per year (adjusted for inflation = $753). That's a rate of $62 per month in 2013 dollars. It could be said that there are more cars (but they're safer), more people to steal them (but they're harder to steal), and so even given that, let's plug in another $40 a month to adjust for that.

The Act could be modified to reduce coverage levels, increase copays, etc.

Of course it could. Then again, the Social Security act could be modified so that it only gave payments to people whose earnings were in the top 20% of their age cohort. That a good law could be modified so as to be a bad law is hardly a relevant or interesting critique of that law, is it?posted by yoink at 2:22 PM on July 17, 2013 [9 favorites]

I found this, which is a great summary of the law. Who knows if it's complete, but it's easier to parse.posted by smidgen at 2:24 PM on July 17, 2013

That a good law could be modified so as to be a bad law is hardly a relevant or interesting critique of that law, is it?

It is, on the other hand, a good reason to vote for people who won't make those changes!posted by yoink at 2:24 PM on July 17, 2013 [4 favorites]

I would kill for $102/month car insurance.

It just makes me wonder what is driving that high cost for your car insurance.posted by smackfu at 2:30 PM on July 17, 2013 [1 favorite]

or that basketball is a sport played by teams of 30 who compete to stuff baloney into the blowholes of whales

That a good law could be modified so as to be a bad law is hardly a relevant or interesting critique of that law, is it?

Of course not. But the law does mandate a captive audience, which should make inevitable changes a cause for concern to anyone following this. I'm hopeful this will help get rising costs under control, because otherwise the parameters for care will likely change so as to reduce quality, and people will likely still be obligated to pay in. Single-payer for all would have pretty much fixed the cost issue, as it has for other industrialized countries, but here we are.posted by Blazecock Pileon at 2:37 PM on July 17, 2013

I would watch the *crap* out of that sport.

Adding the stuff-clock violation definitely improved the pacing, but it moves a lot slower than you'd think.posted by pokermonk at 2:38 PM on July 17, 2013 [2 favorites]

yoink, I've pointed out how the numbers work and my belief that the health insurance industry will subvert the law to get around minimum coverage requirements. Your stating "go read the law" contributes nothing and I award you no points. If you disagree, post a fact or argument of your own.

Well, you posted numbers that wouldn't be permitted under the law, so for limited definitions of 'work'.

This law was specifically structured to continue to allow the insurers to make a profit, the additional people that they'll have to ensure will be matched by the healthy young premium payers that they're gaining because of the mandate. That's the entire point of the mandate and why the whole thing would fall apart without it.

Yes, of course they'll try and produce plans that are as cheap as possible for them to administer. That's why the law is so specific on what has to be covered. That's also why the profits from each pool are regulated - there's no incentive to make more than a certain margin which should act as a general brake on skulduggery not specifically banned by the act.

Also, "they'll try and get around the law" is also an argument for repealing murder laws.posted by atrazine at 2:42 PM on July 17, 2013 [1 favorite]

that basketball is a sport played by teams of 30 who compete to stuff baloney into the blowholes of whales

this sounds amazing. the whales are still in the ocean, i presume? thrashing about? i would watch this for hours.posted by neuromodulator at 3:14 PM on July 17, 2013 [1 favorite]

I'm sure insurers will pull various tricks to try to maximize their profit within the parameters of the law. Some will inevitably push the boundaries into unlawful conduct. However, part of the system is that the government will be paying for decent chunks of these plans through the subsidies, so the government is in a good position to make sure that the money winds up paying for actual health care. How would it be any worse than the situation now, where insurers aren't exactly known for their generosity in coverage decisions?posted by zachlipton at 3:19 PM on July 17, 2013 [1 favorite]

that basketball is a sport played by teams of 30 who compete to stuff baloney into the blowholes of whales

This is not basketball, but I'm 90% sure I saw it on a Japanese game show like ten years ago. They're blindfolded, right? The whales?posted by The Bellman at 3:20 PM on July 17, 2013 [5 favorites]

Sure, I'll come in with an obvious question - the lowest cost per month for individuals I saw was still about $600 or so a month. How, exactly, is that "cheap"?posted by EmpressCallipygos at 3:30 PM on July 17, 2013 [6 favorites]

This is really, really exciting news for me. I think my main question/worry about the exchanges is that so far I've only seen the new figures for two of the most populous and wealthy states, CA and NY. Are poorer states with smaller populations likely to see the same benefits?posted by asperity at 3:32 PM on July 17, 2013

It just makes me wonder what is driving that high cost for your car insurance.

I guess my Zip Code (a gated community in a working class area) I live in and bad credit. For my wife, I actually overstated her payments, they're actually $140. For the record, we both have 0 points on our licenses and no DUIs or accidents.

The dichotomy in what we pay as "model" drivers compared to the information posted here, emphasizes a point about the current weird and inexplicable determination (to me, anyway) of compulsory insurance.

Which brings me back to the issue of having a competitive market driven insurance scale. Higher risk (read:poorer or less favorable) Zip Codes, districts, etc. will pay more than less risky insurance candidates.

While I get it, I'm just quite bothered by what is a power levying a monthly charge against me (whether I utilize medical services or not) simply for existing and being an American.posted by Debaser626 at 3:33 PM on July 17, 2013

And I know utility bills, income taxes, sales taxes etc. are already part of daily life. It's my ego, but I feel like I have the option to opt out (though I really don't) of those things, so its a choice i make, whereas this just seems like a life sentence.

Though I do have a problem with authority and being antisocial, so maybe that's the defect this triggers.posted by Debaser626 at 3:37 PM on July 17, 2013

Sure, I'll come in with an obvious question - the lowest cost per month for individuals I saw was still about $600 or so a month. How, exactly, is that "cheap"?

You can apply for hardship waivers but the qualifications are pretty onerous. The threshold for qualification is such that someone who barely fails to qualify would still be hit quite hard by this added bill. Captive market!posted by Blazecock Pileon at 3:43 PM on July 17, 2013

It's nice that to have more inclusive health care in America, but it's a mess. Why? Because the private medical insurance industry was given large voice during the negotiations. The insurance industry still has their stinking, greedy hands on your money; your Congressional representative's re-election campaign; and, your respective doctor's willingness to accept what s/he gets paid by the government. The private insurance industry is still here, making sure that it gets paid!

Yes, this is an improvement, but starting on Day 1, after this plan was signed into law, American health insurance companies and *anyone else* that stood to lose financial advantage because of this law, began to systematically find ways to protect themselves from that loss.

This is what happens when the profit motive enters any social welfare/infrastructure category - i.e. health care, education, transportation, etc. etc. Corners get cut; people get screwed; politicians/executives ramp up their lying - all in service to quarterly revenues.

We're going to see in the very short term how all this rolls out, and if there is really an improvement for everyone, once the dust settles. The possibility for further improvement for all, without breaking the bank, is there. Here's hoping...posted by Vibrissae at 3:44 PM on July 17, 2013 [1 favorite]

EmpressCallipygos, part of the cheapness comes from subsidies and a federal mandate that you qualify for Medicaid all the way up to 133% of the federal poverty line. Medicaid costs $0 a month, I think.posted by jsturgill at 3:45 PM on July 17, 2013

With the subsidies, a part-time employee at McDonalds might well be paying close to $20 per month for healthcare. Like, good healthcare. Note the chart references silver plans, not bronze.posted by jsturgill at 3:48 PM on July 17, 2013 [1 favorite]

the lowest cost per month for individuals I saw was still about $600 or so a month. How, exactly, is that "cheap"?

Aren't those just the gold and platinum plans that are in that range? This PDF gives quotes for each tier, including Bronze (range of $252 to $589) and Catastrophic (range from $170 to $406), before any applicable subsidies.posted by maudlin at 3:49 PM on July 17, 2013 [2 favorites]

Just on the 60% of average cost, you are going to see a steady stream of stories of people with "bronze" coverage being bankrupted at the emergency room.

But the fact is that the statute doesn't specify the exact mandated standard of coverage... which I believe is still being worked out somewhere swimming with health insurance lobbyists.

Basically, there won't be six figure deductibles but given the potential cost of care, bankrupt is bankrupt.

The people facing the biggest uncertainty aren't the "poor" but those stuck in between without adequate subsidy... And you can bet they are going to look at the young bucks and welfare queens and resent their subsidized hc. Which is what you get when you pass a health insurance reform inspired by the heritage foundation.posted by ennui.bz at 3:49 PM on July 17, 2013

I'm a little confused. Those costs -- and the drop in costs is good news -- still seem much higher than here in CA. I know state-to-state varies for all sorts of reasons, but I wouldn't have suspected they would vary that much.

So, what do you think is going to happen? That people are going to be denied for preexisting conditions even when it is illegal?

If I knew what the loopholes were, I could go into business as a consultant and make millions telling insurance companies how to exploit them. There's a lot of money out there waiting for whoever figures it out, so I'm sure there are a lot of people working on the problem.

This is the key: once we know what the new loopholes are, what are the regulators going to do about them? Will they enforce, or will they accept? Looking at other industries, I expect that the old familiar process of regulatory capture will come into play, and we'll soon see that the people who are supposed to be looking out for the customers of these insurance corporations are actually looking out for the corporations instead.

And, sure, insurance companies have often behaved incredibly badly in the past, but there is something bizarrely out of whack in most people's conception that the health insurance companies are THE great thing wrong with America's health system.

But they are! They add no value. We don't need them, and yet the ACA forces us to deal with them. We'd all be better off with a real national health care system. If we're going to be forced to have health insurance, it should be non-profit public health insurance.posted by Mars Saxman at 3:50 PM on July 17, 2013 [5 favorites]

I spent today combing the NYS site and it looks like they haven't published anything about what the subsidies will look like yet. Without them, it looks pretty expensive. The thing that stresses me out is that it seems the subsidies are supplied through tax credits, which still means we have to pay that huge cost up front, doesn't it?posted by PhoBWanKenobi at 3:52 PM on July 17, 2013

But they are! They add no value. We don't need them, and yet the ACA forces us to deal with them. We'd all be better off with a real national health care system. If we're going to be forced to have health insurance, it should be non-profit public health insurance.

Haven't you heard? 100% of people on nationalized health care end up dead! Those are cold, hard facts, my friend. Prove that I'm wrong.posted by zombieflanders at 3:53 PM on July 17, 2013 [6 favorites]

FWIW, I believe Vermont is trying to pull off state-based single-payer within the framework of the ACA, and California has at least talked about doing the same.posted by feckless at 3:54 PM on July 17, 2013 [1 favorite]

I believe that to be the case, anyway. Please correct me if I'm wrong.posted by jsturgill at 3:54 PM on July 17, 2013

I believe Vermont is trying to pull off state-based single-payer within the framework of the ACA

Pretty sure that's true. We've got a teeny, healthy population and have had state subsidized healthcare since I've lived here (1997?) and investigating this possibility seemed like a good idea. I don't know much more about it but before I worked here at MeFi and had a patchwork of jobs making less than 20K a year, I think I paid $11/mo for my (very good) health insurance. This is one of the websites from an advocacy group supporting it.posted by jessamyn at 3:58 PM on July 17, 2013 [1 favorite]

Everyone making less than what's in the 133% column will get free healthcare under the ACA via Medicaid.

I believe that to be the case, anyway. Please correct me if I'm wrong.

Unfortunately I think this is not the case. This was what the ACA specified, but it's the part of the law that was struck down by the Supreme Court. Individual states get to decide on their own whether they want to participate in the Medicaid expansion.

As far as I can tell, at the moment there's no mechanism in place to pay for coverage for people who don't qualify under their state's current Medicaid laws (say, maybe an adult at 102% FPL) and make less than 133% FPL, so aren't eligible for the subsidies. If someone knows what is expected to happen with those people I would be very curious to hear. I haven't been able to figure it out.

Oh, yes, you're right about that. Fortunately there only a few states willing to hurt so many people for the sake of foolish grandstanding. Most states are expanding coverage, and so in most states, the poor will be much better off in terms of having healthcare options available to them.posted by jsturgill at 4:07 PM on July 17, 2013

But they are! They add no value. We don't need them, and yet the ACA forces us to deal with them. We'd all be better off with a real national health care system.

I agree that we'd be better off with a "real national health care system" but such a thing was not in any conceivable way politically obtainable and it's just stupid and pointless tantrum throwing to let that particular perfect be the enemy of this very real good.

And it is simply NOT the case that the health insurance companies are the main drivers behind the US's insane health market. Remember, it's in the insurance industry's interests to keep health costs down. The less they pay, the better off they are. When people talk about how such and such a procedure costs hundreds (not out of pocket, but to the state) in, say, France and thousands here in the US, that's not the health insurers' fault--that's news that makes them weep for lost profits, not rub their hands with glee. Similarly when people talk about the absurd way Americans rack up pointless tests and procedures that have no proven health benefit that's all pure cost to the insurers, all stuff they would not only prefer not to pay for but would actually be improving the quality of our healthcare if they did refuse to pay.

When you read up on the insane, out of control, profit-driven problems in the US healthcare system, the insurers really aren't a very large part of the picture. Ordinary citizens wildly overstate their role because they are the part of the system they deal with most directly and the only part of the system that has any incentive to tell them "no, sorry, we can't pay for that."

The fact is that one way or the other, whether we had a "national healthcare system" or not we need, as a people, to pay for the job that the health insurers do. If we had a "national healthcare system" we would have to have a huge federal bureaucracy whose job it was to decide what procedures are covered and which are not, when we'll pay for the incredibly expensive new drug and when we'll only pay for the older generation generic etc. etc. etc. Yes, that federal bureaucracy would probably end up being a little cheaper overall than farming that work out to private insurers working through the exchanges will be--but it's a matter of a few percentage points on the total cost of healthcare coverage under either system, not the difference between "everyone gets covered for everything!!" and "the most they'll do is give you a couple of aspirin and tell you to go home."

If you've ever lived, as I have, in states which do, in fact, have national healthcare systems, you'll know that people spend just as much time bitching and moaning about the decisions of the relative state bureaucracies on what they will and won't cover as people do in the US about the decisions of their HMOs etc. That's why well-off people in Canada frequently end up buying supplemental private health insurance, ditto Australia where they, in fact, face a tax penalty if they don't, ditto New Zealand, ditto the UK. National healthcare is, I agree, better than the compromise system cobbled together under the ACA, but the difference is nowhere near as stark as most US liberals, who have a pretty unrealistic conception of what it is actually like to work with a national healthcare system, seem to think.posted by yoink at 4:15 PM on July 17, 2013 [3 favorites]

As far as I can tell, at the moment there's no mechanism in place to pay for coverage for people who don't qualify under their state's current Medicaid laws (say, maybe an adult at 102% FPL) and make less than 133% FPL, so aren't eligible for the subsidies. If someone knows what is expected to happen with those people I would be very curious to hear. I haven't been able to figure it out.

I'm not sure what's being done to actually get these people insurance, but I can tell you that the plan is for the regulations to exempt them from the "individual shared responsibility payment" (the tax penalty):

"Hardship exemptions include:...Individuals who would be eligible for Medicaid but for a state’s choice not to expand Medicaid eligibility. This rule will protect individuals in states that, pursuant to the Supreme Court decision, choose not to expand Medicaid eligibility."

So at a minimum, these folks won't be penalized for their state's refusal to expand Medicaid, which would just be adding insult to injury.posted by zachlipton at 4:21 PM on July 17, 2013 [2 favorites]

I'm in a big fat red state on this map. Foolish grandstanding. Amen.posted by gerstle at 4:25 PM on July 17, 2013

While I get it, I'm just quite bothered by what is a power levying a monthly charge against me (whether I utilize medical services or not) simply for existing and being an American.

I suppose I get that in theory (and the whole idea that the fees have to go to some private company is troublesome to me), but you're also entitled to medical services simply for existing and being somewhere in this country. If you have a heart attack or a stroke right now, you'll get an ambulance ride and treatment regardless of your ability to pay: tens of thousands of dollars worth of care. And those prices aren't hyper-inflated chargemaster prices, they are what actual health insurers spend after applying their negotiated rates.

Since you're legally entitled to this form of care just by existing, we have to pay for it somehow. It turns out, naturally, that we're all a lot better off if you get a physical and your doctor diagnoses your cardiovascular time bomb ahead of time, so you're less likely to have that heart attack in the first place. So we're going to have to pay for that too.posted by zachlipton at 4:43 PM on July 17, 2013 [1 favorite]

I'm just quite bothered by what is a power levying a monthly charge against me...simply for existing and being an American

And the thing about taxes is that they are the price of civilization. You also have to pay for schools even if you don't have kids, you have to pay for roads even if you don't drive, because you benefit from these things no matter what. But people who are struggling just to keep a roof over their heads, at least in our system, are generally burdened with less of this. So, yeah, this is all pretty much the status quo.

If your state is not currently implementing the Medicaid expansion, remember: A lot of states didn't implement Medicaid itself the first year, either. It turns out to be relatively unpopular with voters to turn down free money just to make a point. Everybody wants their piece of the pie. More will follow.posted by Sequence at 4:58 PM on July 17, 2013 [3 favorites]

We'd all be better off with a real national health care system. If we're going to be forced to have health insurance, it should be non-profit public health insurance.

If you've ever lived, as I have, in states which do, in fact, have national healthcare systems, you'll know that people spend just as much time bitching and moaning about the decisions of the relative state bureaucracies on what they will and won't cover as people do in the US about the decisions of their HMOs etc.

On the other hand, some of my mother's friends are moving to Scotland to maximise the chances there's an NHS to care for them in their old age. They know that they're better off with it than without it, 'consumer choice' and what have you be damned.posted by hoyland at 5:01 PM on July 17, 2013

If you've ever lived, as I have, in states which do, in fact, have national healthcare systems, you'll know that people spend just as much time bitching and moaning about the decisions of the relative state bureaucracies on what they will and won't cover as people do in the US about the decisions of their HMOs etc.

Well ... no. That hasn't been my experience at all. I have private health insurance because I can afford it and I have a family, but the last time I needed to draw on it for anything major (i.e., not physiotherapy for a sore back or a diet plan drawn up by a dietician) was years ago. Otherwise, if I'm sick I go see a doctor at my local clinic (paid for by the guvmint). Sometimes my preferred doctor won't have an appointment that day, or I might have to wait for an hour or more even with an appointment. They don't seem very good at scheduling, but this is a lot better than going to some emergency department, right? I don't actually know the cost of most medication because anything over around $36 is paid for by the guvmint too. If my family collectively had to pay more than about $1,400 for medication in one year then that price would drop to around $6.

I have no doubt that there are people poorly served by the Australian medical system, but I can tell you that this hardly ever comes up in conversation. On the other hand, people in the States seem to be constantly worried about getting sick and being wiped out. Constantly! They don't see doctors because they can't afford to. They take jobs because of the insurance benefits. They enter into these complicated calculations about excesses and co-pays and who will take their insurance if they get sick, heaven forfend, and then they know that they will have to spend weeks fighting for reimbursement. I really don't know how you can live like that.posted by Joe in Australia at 5:22 PM on July 17, 2013 [13 favorites]

The thing that stresses me out is that it seems the subsidies are supplied through tax credits, which still means we have to pay that huge cost up front, doesn't it?

yeah, this is what I'm worried about. My income would most likely be well above the poverty line, so I wouldn't qualify for Medicare - but even the silver plans look like they're about 75% the cost of my monthly rent. Unless I get a job with someone who does provide health insurance, of course, but it's also possible I have to make do with a patchwork of temp assignments and pay out of pocket.posted by EmpressCallipygos at 5:29 PM on July 17, 2013

The thing that stresses me out is that it seems the subsidies are supplied through tax credits, which still means we have to pay that huge cost up front, doesn't it?

You can choose to receive the subsidy up front as an Advance Premium Tax Credit:

The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you're due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return.

I think we should talk about costs to the tax payer: so how much would tickets to the aquatic baloney stuffing cost? And can I get a family rate for season tickets?posted by blue_beetle at 5:52 PM on July 17, 2013 [1 favorite]

yeah, this is what I'm worried about. My income would most likely be well above the poverty line, so I wouldn't qualify for Medicare - but even the silver plans look like they're about 75% the cost of my monthly rent. Unless I get a job with someone who does provide health insurance, of course, but it's also possible I have to make do with a patchwork of temp assignments and pay out of pocket.

It's important to remember that this system is not going to be perfect, it's just supposed to be marginally better than the total suck we have right now. It's entirely possible that if you have the sort of job right now that doesn't provide health insurance, you may not be able even with the subsidies to afford the silver plans. That's why the bronze is there. The bronze is not great coverage, but it's better coverage than they offered me the last time I was temping; YMMV. This is not going to be our parents' insurance, for most of us--I know it's hard for me, personally, to look at these things and not find them totally ridiculous, but it's better than nothing.posted by Sequence at 6:01 PM on July 17, 2013 [3 favorites]

My income would most likely be well above the poverty line, so I wouldn't qualify for Medicare - but even the silver plans look like they're about 75% the cost of my monthly rent. Unless I get a job with someone who does provide health insurance, of course, but it's also possible I have to make do with a patchwork of temp assignments and pay out of pocket.

Try plugging your numbers into The Kaiser Family Foundation's Calculator. Obviously, the figures are estimates, and the exact amount of your premium will depend on your state and the plan you choose, but the calculator will tell you what kind of subsidy you'd receive through the tax credit system. The intent of the system is to keep premiums to no more than 9.5% of income at 400% of the federal poverty level, and a much smaller portion at lower incomes.

In addition (as I understand it), you won't have to pay the Individual Shared Responsibility payment (the tax/penalty for not having coverage) if the minimum amount you would have had to pay for coverage is more than 8% of your household income. That doesn't get you insurance obviously (though there are other options, like the bronze plan and the catastrophic plan available to those under 30), but it does mean you're not penalized for being unable to afford something astronomically expensive.posted by zachlipton at 6:05 PM on July 17, 2013 [1 favorite]

...basketball is a sport played by teams of 30 who compete to stuff baloney into the blowholes of whales

I know this was just a witty throwaway comment but we must make this happen.

Agreed. I further suggest liberal use of the term "spam dunk."posted by googly at 6:41 PM on July 17, 2013 [3 favorites]

Helloooooo from the future, future, future (also known as Massachusetts). I am about to buy individual health insurance. At my income point (within 150% of the federal poverty level), health insurance is going to cost me something like $50 a month. For the very first and last time ever, I will loudly proclaim: thanks, Mitt Romney.posted by threeants at 6:46 PM on July 17, 2013 [3 favorites]

I really don't know how you can live like that.

Because otherwise, we have to pay 91837436546% in taxes and our children get mandatory communism herpes.

When you read up on the insane, out of control, profit-driven problems in the US healthcare system, the insurers really aren't a very large part of the picture.

I dunno, man. I get what you're saying, and you are right so far as it goes. On the other hand, say, Ontario has 1 group of people dedicated to not paying too much for health care. In WI, there are 145 licensed insurance companies all with their own groups of people doing the same thing. All with CEOs and board members and staffs and so on.

And that tremendous duplication of effort is BEHOLD! The Efficiency of the Free Market or something.posted by Pogo_Fuzzybutt at 7:13 PM on July 17, 2013 [3 favorites]

Try plugging your numbers into The Kaiser Family Foundation's Calculator. Obviously, the figures are estimates, and the exact amount of your premium will depend on your state and the plan you choose, but the calculator will tell you what kind of subsidy you'd receive through the tax credit system.

One adult my age with no dependents at the bare minimum income I would need would receive NO subsidy, according to that calculator.posted by EmpressCallipygos at 7:17 PM on July 17, 2013

EmpressCallipygos:

I plugged in some fake numbers, and for a single person paying 100% of a silver plan, the annual cost was estimated to be $3616. That is about $301 per month. If that is 75% of your rent, you're paying $401 in rent and $301 for insurance.

To receive no subsidy, you're making at least $38,055 per year according to the calculator.

If you make (ballpark) $40K a year, $702 would be nothing just for an apartment, much less an apartment and decent insurance. The leftover money would be plenty for food, entertainment, and transportation costs pretty much anywhere in North America, even in an expensive city (though you'd be getting a hell of a deal on your rent).

I think maybe somewhere your math is wrong, or mine is.posted by jsturgill at 7:55 PM on July 17, 2013

I'd need $55K to afford my $955 rent, which is well above the point where I'd be getting a subsidy.

And now that I do the math it wouldn't be 75% of my rent, but still an extra $400 or so a month on top of my other expenses would be tight.posted by EmpressCallipygos at 8:11 PM on July 17, 2013

I wonder if the person quoted in the Times article about going from Bergdorf's to Filene's really knew what she was saying, because it's actually more profound than just the cost, based on the kind of mensch Edward Filene was:

"He favored paying workers a 'buying' wage instead of a marginal 'living' wage. He initiated profit-sharing, health clinics, paid vacations, and welfare and insurance programs. He also established minimum wages for female workers and introduced a five-day, 40-hour work week. In the early 1900s, ideas like these were revolutionary."posted by adamg at 8:15 PM on July 17, 2013 [6 favorites]

But on health insurance, I have a $5,000 ER deductible on my cheapo work plan. ($75 month employee contribution). Wasn't a big deal until I had to go to the hospital recently.

Sure, I'll come in with an obvious question - the lowest cost per month for individuals I saw was still about $600 or so a month. How, exactly, is that "cheap"?

I’m paying $1100 a month with a $5000 deductible, so they never pay for anything. If that dropped to $600 there might be real tears around here. I want to backhand anyone who tries to get in the way of the ACA. And it better be the first step towards a real national health care system.posted by bongo_x at 9:51 PM on July 17, 2013 [5 favorites]

Oh, goodness, I wasn't saying that this should be stopped - this is more of a grumble of this not going far enough so let's keep going.posted by EmpressCallipygos at 9:52 PM on July 17, 2013 [1 favorite]

While I am generally a fan of the ACA, I am frustrated that I can't be proud of it. I look over the fence at Canada, or over the pool to France, Germany, Japan, Sweden, Finland, etc. and their healthcare systems are still far, far superior by contrast. I am still envious.

US voters have won a tossed bone while the rest of the developed world dines on a full meal. It is certainly better than nothing, and a step in the right direction...but there is a ways to go.posted by jnnla at 12:24 AM on July 18, 2013

I think that we'll be proud of it eventually, once most of the issues get shaken out. I'm pretty sure that the Republicans are going to regret pinning the name Obamacare on the ACA.posted by octothorpe at 4:22 AM on July 18, 2013 [1 favorite]

Making everyone in the country eligible for Medicare would be so easy! Heartbreaking it's not being considered. I want to smack anyone over 65 who complains about the evils of "socialized medicine" - you have yours, we want in, too!posted by ThePinkSuperhero at 5:41 AM on July 18, 2013 [3 favorites]

On the other hand, people in the States seem to be constantly worried about getting sick and being wiped out. Constantly! They don't see doctors because they can't afford to. They take jobs because of the insurance benefits.

People with good health care aren't exactly going to be talking about it in these threads.posted by smackfu at 6:03 AM on July 18, 2013

> "People with good health care aren't exactly going to be talking about it in these threads."

Even people with good health care in the U.S. are pretty aware that private insurance companies would eagerly screw them over, drop them without a second thought, and watch them go bankrupt or die with neither pity nor remorse the second the company thought it was worth it to do so. Many people with good health care in the U.S. know someone this has happened to, and practically all of them have heard of it happening. If their "good health care" is tied to their job, as it generally is, they may very well find themselves taking or keeping jobs they don't like, moving places they hate, and avoiding even attempting self-employment or entrepreneurship out of fear that someday they might get sick.

"Good health care" in the United States is a sick joke unless you are rich enough not to have to worry about such things at all. Any step away from this nightmare is welcome.posted by kyrademon at 6:17 AM on July 18, 2013 [2 favorites]

People with good health care aren't exactly going to be talking about it in these threads.

So you're saying there's a great divide in the USA between people with "good health care" and those without?posted by Joe in Australia at 6:19 AM on July 18, 2013

Sure. My argument is that there are a lot of people who are not "constantly worried about getting sick and being wiped out." Despite what you read on the internet.posted by smackfu at 6:20 AM on July 18, 2013

I have gold plated, platinum highlighted, diamond encrusted heathcare courtesy of my wife's very generous company and I still worry about getting sick and getting wiped out since no matter how good the insurance is, it's still tied to employment. What if we both lose our jobs and can't get new ones right away?posted by octothorpe at 6:37 AM on July 18, 2013 [2 favorites]

... Not to mention that people who get terribly sick might have some slight problem hanging on to a job, for that matter ...posted by kyrademon at 6:44 AM on July 18, 2013 [2 favorites]

when i was in college, i did a report on the hidden nature of healthcare bankruptcy.
this was back in like 2007.

because people used credit cards and 2nd mortages to pay for health care costs, they often go bankrupt because of these things rather than health care costs directly.

i should try to find the study and do an fpp on it. it was pretty amazing/sad.

i plugged in my number for my last job into the KFF calculator. i was making 1/2 of what i make now and my employer offered no health ins. i would pay $200/month for the silver. if i was 21 instead of 33, i'd pay $250.

and i would have. gladly. because that means i could go to the doctor when i needed to.
sure, it would mean less money for other things, but hey, I CAN HAZ DOCTOR!!!! i don't get sick, but when i do, i like medication and stuff.

i am EXTREMELY fortunate to have 100% awesome paid for by my employer health care now, but if i ever got sick and couldn't work, it would make me way less stressed to know that i might not lose everything i have due to that illness.

i hope that one day on askme we are able to stop having questions about "i really need to go the doctor but i can't afford it, what can i do?" or "my medication that keeps me sane/alive is prohibitively expensive even with insurance and i don't quailfy for medicare, what can i do?".

this is HUGE step forward, even if it's imperfect. it actually kinda makes me teary.posted by sio42 at 7:14 AM on July 18, 2013

In Ontario, you can't get private insurance for anything already covered by OHIP. Supplemental private insurance is useful only for things not covered by OHIP, like prescriptions, eye exams, and physiotherapy.posted by one more dead town's last parade at 7:22 AM on July 18, 2013

When health insurers’ don’t meet these standards, they are required to send a rebate check to their subscribers, making up the difference. And that’s what President Obama is talking about today, the 8.5 million U.S. families receiving rebate checks from their health insurance plans this summer. That’s a decrease from the 12.1 million families who received rebates last summer.

The health law has a number of tools aimed at reducing the cost of health care. There is the direct competition in the marketplaces, which the White House expects will drive down premiums. There are experiments to reimburse doctors based on the value of the care they provide rather than the volume.

It’s hard to know, though, how well those will work: The research on competition and health prices is incredibly mixed. Moving into a value-based health system is incredibly hard.

The medical loss ratio, in that context, is relatively easy: It’s a firm requirement for insurers to spend more on medical care and less on administrative cost. It should be no surprise, then, that this is the provision that terrifies insurers.

On the other hand, people in the States seem to be constantly worried about getting sick and being wiped out. Constantly! They don't see doctors because they can't afford to. They take jobs because of the insurance benefits.

I know quite a few people who don’t feel like this, but they are all very well off. Everyone I know who isn’t rich lives like this.posted by bongo_x at 9:17 AM on July 18, 2013

I have good health care now, but as said above, knowing it's tied to my employment means I could lose it at any time. My department was undergoing some staffing changes right around when I got pregnant, including laying off the executive I assisted, and I was terrified I was going to get laid off and lose my health insurance. I even asked my doctor's office if they would keep me as a patient if I had to go on Medicaid.posted by ThePinkSuperhero at 9:19 AM on July 18, 2013

Here are some pre-ACA numbers from a family who already buys individual insurance, namely mine. We had to roll to individual insurance when my husband lost his Rolls-Royce (seriously, so much better than Cadillac*) plan when he lost his job when I was 29 weeks pregnant with our second child; we paid the $2000/mo for COBRA until the delivery, and then rolled to individual insurance.

To cover our family of 4 (two non-smoking adults, 43/m and 38/f, and two children under 18), we pay just about $760 per month. That coverage includes a $2500 deductible (each) and 25% coinsurance after the deductible is reached, but no copay for office or urgent care visits. The first 6 visits are deductible-waived, as are well-child and vaccination appointments. Our son's Early Intervention therapy services are covered in their entirety, which was a nice surprise. There's a nice robust network of physicians and specialists. It's roughly equivalent to a Silver ACA plan.

Here's what it doesn't cover: Prescription drugs, at all. Maternity, at all. Fortunately we're done having kids; also fortunately, new this year it covers Mirena and vasectomy. It didn't use to.

You may note that this level of coverage is way better and way less expensive than it is in many other states. I can't be certain, but I believe that this is due to the WSHIP, the Washington State Health Insurance Pool, which mandates that people who are more than a certain amount sick can (I think, the language is so unclear) qualify for Medicaid regardless of income. IOW, we have kind of a public option.

Our household income is right around the median for our county; we are lucky enough that we get that in one earner's wages, and thus don't have to pay for child care. But both my kids have weird low-level chronic conditions that we're currently in the diagnosis / followup stage for, and if Seattle Children's didn't have an extremely generous financial aid policy that means that they eat everything our insurance doesn't cover, we would be in a tight spot indeed.

*no copays, no deductibles, no limits, nearly everything was in network, 100% of the premiums were employer paid. We just didn't pay for health care, period.posted by KathrynT at 9:26 AM on July 18, 2013 [1 favorite]

"People with good health care aren't exactly going to be talking about it in these threads."

I have good insurance now, but I've only had it for about a year and a half, and before that I had a bicycle accident that left me with a couple broken bones and medical bills well into six figures. Not only that, but my parents, who have chronic health issues, have insurance only because my mother works at a university enough to qualify for her and my dad, and every summer there's a worry about whether she'll get enough classes as an adjunct to continue the coverage.

Most of my friends lack comprehensive insurance, with most of them cobbling together emergency plans and social capital. Health insurance is probably the biggest reason for why I have a regular job instead of working as a freelance journalist — I've had a big enough scare that I don't ever want to be without it, and I was never able to get enough consistency in my gigs to support rent+expenses+individual health care.

For many of my married friends, it's the primary reason why they stopped just living together and tied the knot — one got good health care and wanted to cover the other.

I have good health care now, but I realize that — especially with the deprecation of the notion of working for one company for the majority of a career — it's tremendously unstable, and the safety net has huge holes in it. So even though I'm good now, it's a source of low-level anxiety.

Plenty of people may have good health care, but that's not really something that I feel is a national norm.posted by klangklangston at 9:31 AM on July 18, 2013 [4 favorites]

My insurance is pretty good- which means I can't easily leave my job. I don't particularly feel a need to leave it right now, but still, I feel trapped. (And yeah, you could say that's a good problem to have but isn't that sad? That I'm one of the lucky ones?)posted by showbiz_liz at 9:53 AM on July 18, 2013

My insurance is pretty good- which means I can't easily leave my job. I don't particularly feel a need to leave it right now, but still, I feel trapped. (And yeah, you could say that's a good problem to have but isn't that sad? That I'm one of the lucky ones?)

I feel like most people could say the same thing about their mortgages or their kids' college funds or just the lifestyle to which they've become accustomed. That's just... life, y'know? We're all trapped to varying degrees (positively or negatively) in our own situations for various reasons.

There's certainly an argument to be made that health care shouldn't be one of the things that does that, since no one chooses to have major medical practices, but that change will be a significantly larger one than even making sure that everyone has some form of insurance.posted by Etrigan at 11:05 AM on July 18, 2013 [1 favorite]

I have good health care now, but as said above, knowing it's tied to my employment means I could lose it at any time.

I had good health care until a month ago, through my employment. Then my job issued a whole round of layoffs.

>There's certainly an argument to be made that health care shouldn't be one of the things that does that

It's somewhat infuriating that it is one of the things that does that, because all other western nations have figured out how to avoid putting their citizens in the quandary that showbiz_liz describes.

Whether it's nationwide single-payer like Canada, or fully socialized medicine like the UK, or systems like Germany and Switzerland that involve a mix of public and private entities… they've all made it so that everyone receives the same quality of care, no matter who is actually paying for it.

Hacks like COBRA only drive the point home. If I leave my job right now, I can stay on my health plan (for a while) by paying the premiums in full, but once COBRA runs out, I can't even find a comparable plan on the individual market. (Though this will change next year, of course.) But there's no good reason why I shouldn't be able to stay indefinitely in the group plan I had before, no good reason why that particular risk pool should be correlated to the employees of a particular company, no good reason why we shouldn't have just one nationwide group plan and end all this employer fuckery.posted by savetheclocktower at 11:26 AM on July 18, 2013 [4 favorites]

but once COBRA runs out, I can't even find a comparable plan on the individual market.

Yeah, that's true. Let's say that I somehow was worth a billyun dollars; I couldn't buy health insurance like our old Microsoft insurance at any price. It's simply unavailable.posted by KathrynT at 11:30 AM on July 18, 2013 [1 favorite]

People with good health care aren't exactly going to be talking about it in these threads.

I've had "good health care" before, and while it's a huge relief to know your life won't be ruined over a minor health incident, I'd really describe it more as minimally acceptable than as truly "good". In my opinion, there are some major systemic/cultural problems (not necessarily unique to the US) that prevent us from having truly good health -space- care even if everyone suddenly had "good insurance". It truly amazes me that, say, anyone ever has an unexpected disease detected atall in the course of their twelve-minute doctor's visit.posted by threeants at 12:28 PM on July 18, 2013 [2 favorites]

I’m not sure congressional Republicans really want to enter a promising midterm election year just having engineered another phony crisis, but I also don’t know if they can put this particular genie back in the bottle. It’s taken a few years, but the GOP has managed to talk itself into a very firm belief that this national version of Mitt Romney’s Massachusetts health plan is a satanic abomination that will either, depending on which talking point they are following at any particular moment, crash and burn taking the entire U.S. economy down with it, or succeed in seducing Americans to sell themselves into the voluntary slavery of “socialized medicine.”

At a time when major elements of the GOP’s conservative “base” are already convinced—because they hear it constantly from conservative media gabbers—that the only thing standing in the way of total victory for The Cause is the weakness of GOP lawmakers, the “kill Obamacare or shut down the government” war cry could quickly get way out of hand. It doesn’t help that so many conservatives continue to believe, notwithstanding all the evidence to the contrary, that a government shutdown would show Americans how little they actually miss Big Government.

If Mitch McConnell and John Boehner don’t like the idea, they’d better come up with an alternative strategy for dealing with the autumn fiscal “crisis” and give it some momentum. Otherwise the thrill of imagining themselves denying government-enabled health insurance to 25 or 30 million people could so excite conservative activists that there will be no stopping them.

CVS pharmacies intend to help customers navigate the available benefits and enroll eligible people in exchanges.

When it comes to raising public awareness, this is an important step for the national system. When it comes to politics, it's a reminder of just how strange some political players can be -- Fox News' Erick Erickson said yesterday CVS Caremark's "support" for "Obamacare" means he intends to shop at Walgreens.

Except, when Erickson probably doesn't know is that Walgreens recently announced a partnership with the Blue Cross Blue Shield Association to promote the health law, too.

In fact, I'll be eager to see how the right deals with this trouble in the coming months -- because their hysterical opposition to the law may make their lives a little ... tricky.

Private businesses like CVS and Walgreen want to make money, of course, and see a growing pool of customers who'll be eligible for new benefits. To that end, they want to help those customers, probably because it'll help their bottom line.

For folks like Erickson, the proper response is to launch an informal boycott, which is certainly his right. But exactly how far will far-right activists go in this endeavor? Drugstores that want more customers are apparently going to make conservatives' do-not-shop-there list, but what about doctors' offices who see patients who take advantage of Affordable Care Act benefits? Or hospitals? Or private insurers? Or manufacturers of medical equipment?

For Erickson and those who share his odd worldview, how far are they prepared to retreat from the nation's health care marketplace because their contempt for the new federal law has spiraled well past the point of reason?

Three years after the law passed, one year after the U.S. Supreme Court upheld it, and nine months after Republicans lost the election that might have allowed them to repeal it, the Washington conversation is still about Republicans' rearguard actions to undermine the Affordable Care Act and profit politically from the damage.

But in a cavernous room in New York's SoHo district, a group of entrepreneurs is working to render the entire Washington conversation over Obamacare obsolete. There, Obamacare is no longer a political controversy: It's a business opportunity...

Come Oct. 1, all 50 states and the District of Columbia will open health insurance marketplaces (sometimes called "exchanges") to serve people who don't get coverage from their employer or a government program. The insurers in these online marketplaces won't be able to discriminate based on existing conditions. They have to offer a core package of essential benefits and clear pricing information. And they're about to see a flood of first-time customers.

In New York, one of those insurers will be Oscar. That's the name Kushner and his co-founders chose, hoping it would help humanize their company. "I don't think we could do this without Obamacare," Schlosser said. "You'd have to break into a market that's been pretty 'oligopolized' with big insurers catering to brokers, agency houses and big employers. But now we have a direct connection to the consumer."

The idea behind Oscar is that using your insurance should be as easy and intuitive as using your Facebook account or your Tumblr page. As Nazemi puts it, "We have a responsibility to take the friction and pain of engagement out of the process." The experience is familiar to anyone who uses today's leading social networks (the former head of engineering at Tumblr now works for Oscar). But for anyone who's used the Web sites of Aetna or Cigna or Blue Cross Blue Shield, it's something of a revelation.

Sign into your Oscar insurance account online, and you'll see a few carefully chosen options on a page that's otherwise white and clean. At the top, you can type in your symptoms and be taken immediately to a guided set of options, including a button that lets you talk to a doctor. Click it, and a doctor will call you, wherever you are, whatever time of day it is, within 20 minutes. If you need to see someone, the site will offer a list of nearby providers, tell you which ones are recommended for your condition and tell you how much each is likely to cost...

The pattern isn't exactly subtle: if you live in a state where officials want "Obamacare" to work, the law looks great. If you live in a state where officials are actively trying to undermine the law, regardless of what it does to you, your premiums, and your family's access to quality and affordable care, then -- you guessed it -- the news isn't as encouraging.

Now, some of this is the result of silly gamesmanship. In Indiana, for example, premiums aren't really set to spike -- it only looked that way because GOP officials in the state cooked the books to get a more politically convenient result. For that matter, if the feds can meet their deadlines, they'll hopefully run the exchanges in obstinate states pretty well, too.

In other words, even folks in ruby-red states are poised to benefit greatly, whether their elected state officials want them to or not.

That said, the emerging pattern nevertheless suggests folks in states like Maryland, New York, California, and other bluer-than-blue states are going to be immediately happier with the results of the federal health care law because they're living in states where officials actually want the system to work effectively.

My question is, what happens in those red states when residents start looking across borders and they wonder to themselves, "Why aren't my benefits as great as theirs?" In theory, this should prompt those folks to start asking their state officials to do more of what works.

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